The Cleveland Clinic Kidney Biopsy Epidemiological Project

Abstract

Background: The kidney biopsy is the gold standard for the diagnosis of glomerular diseases. Large-scale, epidemiological studies describing the prevalence of kidney diseases are lacking especially in the US. We aimed to determine the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. Methods: We identified all patients with a native kidney biopsy performed/reviewed at the Cleveland Clinic from January 2015 to September 2021. Retrospective chart review was performed to obtain clinical and demographic characteristics. Results were stratified by age, gender, race and location to determine epidemiological trends. Results: Of over 9600 patients, we excluded transplant/donor biopsies and unavailable records, and included 4128 patients with native kidney biopsy data. The median age was 60 years, with 46.2% female patients. Self-reported racial demographics included 72.9% White, 21.7% Black, 3.1% multi-racial, and 1.6% Asian background, with 5.1% Hispanic. Common diagnoses were: FSGS (n=633, 15.3%), diabetic kidney disease (DKD) (n=602, 14.6%), IgA nephropathy (n=319, 7.7%), lupus nephritis (LN) (n=289, 7.0%), pauci-immune glomerulonephritis (n=275, 6.7%), membranous nephropathy (n=211, 5.1%), and amyloidosis (n=110, 2.7%). There were 3322 patients in Ohio, with 361 patients in Florida. Using multivariate analysis, those over 70 years were more likely to have FSGS, while those less than 45 years were more likely to have IgA Nephropathy or LN. Males were more likely to have FSGS or IgAN and less likely to have LN. Blacks were more likely to have FSGS, DKD or LN. Hispanics were more likely to have DKD. Finally, patients in Florida were more likely to have LN. There was no change in the disease spectrum prior to and during the COVID 19 pandemic. Conclusion: Our study catalogues the spectrum of biopsy proven kidney disease across the Cleveland Clinic enterprise. This lays the foundation for glomerular disease clinical trials and highlights the need for a standardized national kidney biopsy registry to bolster glomerular and kidney disease research in the United States.

Exploring hospital practice types and their impact on glomerular pathologic patterns: Insights from the largest kidney biopsy cohort in Thailand

“…This registry revealed variations in the age and gender distribution among different practice patterns. The average age of patients in this study was comparable to previous reports from Thailand but lower compared with other countries 6,8,9,11–13 . Older age has been associated with different final diagnoses in various registries, with several studies indicating a correlation between glomerular injury patterns and patient age 6,8,9,14 .…”

“…Older age has been associated with different final diagnoses in various registries, with several studies indicating a correlation between glomerular injury patterns and patient age 6,8,9,14 . For instance, a large epidemiological report from the Cleveland Clinic involving 4123 patients demonstrated that individuals over 70 years of age were more likely to have FSGS, while those below 45 years had a higher likelihood of IgAN 9 …”

“…Numerous kidney biopsy registry studies have been conducted to assess the epidemiology of pathologic findings and indications for kidney biopsy 6–9 . These studies have shed light on the diverse patterns of glomerulonephritis (GN) observed in different geographic regions.…”

“…1 Numerous kidney biopsy registry studies have been conducted to assess the epidemiology of pathologic findings and indications for kidney biopsy. [6][7][8][9] These studies have shed light on the diverse patterns of glomerulonephritis (GN) observed in different geographic regions. These variations may be influenced by factors such as age, race, environmental conditions, genetic predisposition, and socioeconomic factors.…”

“…Kidney biopsy indication classified by hospital practice patterns. demonstrated that individuals over 70 years of age were more likelyto have FSGS, while those below 45 years had a higher likelihood of IgAN 9. …”